Burning, numbness, or a pebble under your forefoot

Foot pain in runners is usually tissue that has been asked for too much: a tendon, a bone, the plantar fascia. Our guide to foot pain by location sorts those out. A smaller group is nerve, and it is worth separating because it responds to different things.

The words that separate it

Nerve pain has its own vocabulary. Burning. Tingling. Electric. Numb. A feeling that something is in the shoe when nothing is.

Tendon and bone pain do not usually produce those. They produce ache, tenderness you can press on, and pain that tracks how much you did yesterday. If you find yourself reaching for the nerve words to describe it, that is worth noticing.

A pebble between the toes

The classic presentation is pain in the ball of the foot between the third and fourth toes, sometimes the second and third, with a sensation of a stone underfoot or a rucked-up sock. It often comes with numbness in the facing sides of those two toes. Taking the shoe off and rubbing the foot helps, which is a detail people mention unprompted.

Narrow shoes, and anything that squeezes across the forefoot, make it worse. That is the mechanism rather than an incidental detail.

Two things in that are worth holding on to. The name is misleading, which matters because being told you have a neuroma sounds like something that has to be cut out. And even the surgical option leaves roughly one in six people unimproved, which is a good reason to take the conservative route seriously rather than as a delay before the real treatment.

Burning along the inside of the ankle

A different pattern, and a less common one. Burning or tingling that starts around the inside of the ankle, below the bony bump, and spreads into the sole or the toes. It tends to get worse the longer you are on your feet and can be present at night. Pressing behind that inside ankle bone may reproduce it.

That is the region where the nerve passes through a confined space on its way into the foot, and irritation there produces symptoms across a much larger area than the spot itself. Pain further forward along the same inside line, without the burning, is more likely the tendon that runs alongside it, which our tibialis posterior guide covers.

What a scan adds, and when

For Morton's, if imaging is needed, the cheaper option is as good as the expensive one.

That matters practically, because ultrasound is quicker to get and considerably cheaper. It also matters that these studies used surgery as the reference standard, so they describe accuracy in people who went on to have an operation rather than in every runner with a sore forefoot.

The more useful point is that neither scan changes the first step. A wider shoe and a load adjustment is where this starts either way.

What we would actually do

Space first. A shoe with genuine width across the forefoot, laced so it is not pulled tight over the ball of the foot, and no narrow racing shoe until symptoms have settled. For some people a pad placed just behind the sore spot helps by spreading the metatarsal heads.

Then load. Reduce the sessions that provoke it, which for forefoot nerve symptoms is usually fast running and hills, because both push you further onto the forefoot for longer.

Then capacity, once symptoms are quiet: calf and foot strength, built back gradually, so the forefoot can take what you are going to ask of it again.

When to get it looked at

Nerve symptoms in both feet in particular are worth a medical opinion rather than a running one, because the causes worth excluding are not in the foot³.